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Valley Fever Valley Fever

Edward Moreno, MD, MPH Edward Moreno, MD, MPH Director and Health OfficerDirector and Health OfficerFresno County Department of Public Fresno County Department of Public HealthHealth

David Luchini, PHNDavid Luchini, PHNDivision Manager of Community HealthDivision Manager of Community HealthFresno County Department of Public Fresno County Department of Public HealthHealth

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OverviewOverview

What causes Valley FeverWhat causes Valley Fever What are the symptomsWhat are the symptoms Should I get checkedShould I get checked Who gets itWho gets it What is being done about Valley What is being done about Valley

FeverFever Can I protect myselfCan I protect myself

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What causes Valley What causes Valley FeverFever CauseCause

– Coccidioides immitis Coccidioides immitis is a mold that grows is a mold that grows in the dirt during in the dirt during the wet season and the wet season and spreads through the spreads through the air during dry warm air during dry warm seasonseason

Exposure Exposure – People inhale the People inhale the

spores of the fungusspores of the fungus

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What are the What are the symptomssymptoms Disease Disease

– Most people have no symptomsMost people have no symptoms– 40% have flu symptoms including 40% have flu symptoms including

pneumoniapneumonia– 1% have disseminated infection1% have disseminated infection

Bones, skin and brainBones, skin and brain

– Valley Fever is not contagiousValley Fever is not contagious

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What are the What are the symptomssymptoms Treatment and recovery Treatment and recovery

– Treatment is availableTreatment is available– Most individuals recover over Most individuals recover over

several weeksseveral weeks– Few develop chronic illnessFew develop chronic illness– Rarely leads to deathRarely leads to death– Lifelong immunityLifelong immunity

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Should I get checkedShould I get checked

Healthy individualsHealthy individuals– No need to be checkedNo need to be checked– No vaccine or medicine to prevent No vaccine or medicine to prevent

valley fevervalley fever Individuals with symptomsIndividuals with symptoms

– Tell health provider that you live in Tell health provider that you live in endemic areaendemic area

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Who gets Valley FeverWho gets Valley Fever

Endemic regionsEndemic regions– San Joaquin San Joaquin

ValleyValley– Sonora DesertSonora Desert– South AmericaSouth America

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Who gets Valley FeverWho gets Valley Fever

Risk factors for severe or Risk factors for severe or disseminated diseasedisseminated disease– Age, gender, race, chronic disease, Age, gender, race, chronic disease,

prior exposureprior exposure

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Valley Fever Valley Fever in Fresno Countyin Fresno County

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Coccidioidomycosis in Coccidioidomycosis in S/W Fresno CountyS/W Fresno County

Coalinga PVSP

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Coccidioidomycosis Coccidioidomycosis Cases and Incidence Rates in FresnoCases and Incidence Rates in Fresno

YearYear County County PopulatioPopulatio

nn

Total Total CasesCases

Cases Cases per per

100,000100,000

20042004 846,912846,912 122122 1414

20052005 848,226848,226 290290 3434

20062006 895,919895,919 760760 8585

20072007 918,107918,107 450450 5050

20082008 931,098931,098 310310 3434

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Total Cases of Coccidioidomycosis in Total Cases of Coccidioidomycosis in Fresno County/Coalinga for the last 5 Fresno County/Coalinga for the last 5

YearsYears

20042004 122122 7676

20052005 290290 142142

20062006 776776 674674

20072007 450450 342342

20082008 310310 244244

Year Fresno County Coalinga

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County, Coalinga and PVSP County, Coalinga and PVSP Coccidioidomycosis Coccidioidomycosis Total Cases by YearTotal Cases by Year

0100200300400500600700800

Total Cases

2004 2006 2008

Year

CountyCoalingaPVSP

1414

County, Coalinga and PVSP County, Coalinga and PVSP Coccidioidomycosis Coccidioidomycosis

Incidence Rates by YearIncidence Rates by Year

0

2000

4000

6000

8000

10000

12000

Cases per 100,000

2004 2005 2006 2007 2008

Year

CountyCoalingaPVSP

1515

Outbreak InvestigationOutbreak Investigation

Several agencies involvedSeveral agencies involved– Fresno County Department of PublicFresno County Department of Public– California Department of Corrections California Department of Corrections

and Rehabilitationand Rehabilitation– California Department of Public California Department of Public

HealthHealth

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Investigation FindingsInvestigation Findings

Clinical EpidemiologyClinical Epidemiology– 60% Pulmonary Disease60% Pulmonary Disease– 7% Disseminated Disease7% Disseminated Disease– 24% Hospitalized24% Hospitalized– 4 Deaths4 Deaths

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Investigation FindingsInvestigation Findings

Environmental considerationsEnvironmental considerations– Construction of facilities and housingConstruction of facilities and housing– Wet winters followed by arid Wet winters followed by arid

summerssummers

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Investigation FindingsInvestigation Findings

Health considerationsHealth considerations– Growing populationGrowing population– Individuals with no prior exposureIndividuals with no prior exposure– Enhanced screening by physicians Enhanced screening by physicians

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Department of Public Department of Public Health Health RecommendationsRecommendations Mitigate environmental factorsMitigate environmental factors Relocate high risk inmatesRelocate high risk inmates Enhance surveillance and Enhance surveillance and

epidemiologyepidemiology Continue vaccine researchContinue vaccine research

2020

CDC FindingsCDC Findings

MMWR February 13, 2009 MMWR February 13, 2009 – Increase in Valley Fever cases in CA Increase in Valley Fever cases in CA – 2000-2006 Incidence rate tripled 2000-2006 Incidence rate tripled – Highest incidence rate in Kern CountyHighest incidence rate in Kern County– Highest hospitalization rate among Highest hospitalization rate among

non-Hispanic blacksnon-Hispanic blacks– 76% of California’s cases were 76% of California’s cases were

reported from San Joaquin Valleyreported from San Joaquin Valley

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CDC FindingsCDC Findings

People at risk for severe or People at risk for severe or disseminated diseasedisseminated disease– Older personsOlder persons– Pregnant womenPregnant women– Immunocompromised personsImmunocompromised persons– African AmericanAfrican American– Filipino ancestryFilipino ancestry

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CDC RecommendationsCDC Recommendations

People living in People living in endemic areasendemic areas– Avoid exposure to Avoid exposure to

outdoor dust as outdoor dust as much as possiblemuch as possible

– Wet soil and use Wet soil and use masksmasks

– Close windows Close windows and use air and use air conditioningconditioning

People traveling to People traveling to endemic areasendemic areas– Tell physician that Tell physician that

you will visit or live you will visit or live in endemic areain endemic area

– Learn about the Learn about the diseasedisease

– Avoid exposure to Avoid exposure to outdoor dust outdoor dust

– Close windows and Close windows and use air conditioninguse air conditioning

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Thank YouThank You